Early blindness and coma during intrathecal chemotherapy for meningeal carcinomatosis.
A 35-year-old woman was treated with intraventricular methotrexate (MTX) with a total dose of 70 mg followed by cytosine arabinoside (Ara-C) with a total dose of 80 mg for meningeal metastasis of breast carcinoma. Radiation therapy was not given. Despite a response of the meningeal tumor the patient developed in the third week of MTX treatment a progressive visual loss and loss of consciousness which worsened during subsequent Ara-C treatment and led to death within 3 weeks. Postmortem examination revealed only minimal neoplastic infiltration of the meninges. Multiple foci of axonal degeneration and demyelination were found in the optic nerves and chiasm, the superficial layers of the brainstem, and spinal cord and to some extent in other cranial nerves and spinal nerve roots. The possible causes of this previously unreported early complication are discussed.
Boogerd
W
W
Department of Neurology, Netherlands Cancer Institute (Antoni van Leeuwenhoekziekenhuis), Amsterdam, The Netherlands.
Moffie
D
D
Smets
L A
LA
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001766:Blindness / Q000139:chemically induced*; D001943:Breast Neoplasms; D003128:Coma / Q000139:chemically induced*; D003561:Cytarabine / Q000008:administration & dosage; D003711:Demyelinating Diseases / Q000139:chemically induced; D005260:Female; D006801:Humans; D007276:Injections, Intraventricular; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*
D003561:Cytarabine; D008727:Methotrexate